{"id":633103,"date":"2025-08-06T17:39:21","date_gmt":"2025-08-06T21:39:21","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=633103"},"modified":"2025-08-06T17:39:21","modified_gmt":"2025-08-06T21:39:21","slug":"what-to-do-if-you-lose-birth-control-coverage","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-to-do-if-you-lose-birth-control-coverage\/","title":{"rendered":"What to do if you lose birth control coverage"},"content":{"rendered":"

A health insurance company may change its <\/span>formulary<\/span><\/a> (the list of drugs it will cover) at any time, and sometimes these changes affect prescription contraceptives. The average woman tries <\/span>more than three birth control methods<\/span><\/a> in her lifetime, and losing birth control insurance coverage may mean trying yet another. It can be frustrating to trade a trusted contraceptive for an alternative that may be unfamiliar or less tolerable, but there\u2019s good news: you may not have to switch your birth control at all. Let\u2019s take a look at what you can do when your insurance stops covering birth control.<\/span><\/p>\n

Possible reasons why your insurance stopped covering birth control<\/span><\/h2>\n

Your insurance probably stopped covering your specific birth control because a lower-cost generic version became available. Insurance companies are required by law to cover generic FDA-approved contraceptives. More specifically, they must cover at least one contraceptive in each category. There isn\u2019t much wiggle room for dropping birth control coverage for any other reason.\u00a0<\/span><\/p>\n

\u201cInsurance companies are always trying to manage expenses, so if a generic version of a name-brand product becomes available, they may encourage people to switch to it,\u201d says <\/span>James Lyons<\/span><\/a>, a hospitalist and physician in Austin, Texas, and a medical consultant at <\/span>Synergy Houses<\/span><\/a>. \u201cSometimes it\u2019s also about negotiations between insurers and drug companies. In some cases, coverage might be limited due to religious or moral objections. That is less common, but it does still happen.\u201d\u00a0<\/span><\/p>\n

It\u2019s true that payers defined as \u201chouses of worship\u201d <\/span>don\u2019t have to follow<\/span><\/a> birth control coverage laws in their health plans. In addition, some health plans were grandfathered in when the laws were enacted in 2012 and may continue to deny coverage for birth control products.\u00a0<\/span><\/p>\n

However, Dr. Lyons says most insurance plans cover some kind of birth control. \u201cIt\u2019s not usually done in a way that means all birth control is removed. It\u2019s more common to see specific brands or types no longer covered. It can be frustrating if someone has been doing well on a particular brand.\u201d\u00a0<\/span><\/p>\n

Alyssa Small Layne<\/span><\/a>, MD, a D.C.-based board-certified OB-GYN and the founder of <\/span>Junie<\/span><\/a>, has had similar experiences. \u201cI\u2019ve never seen an insurance company drop coverage for all forms of contraception, but they often change which formulations, brand names, medications, or devices they will cover.\u201d<\/span><\/p>\n

\u201cI\u2019ve been in practice for eight years and I\u2019ve learned not to tell patients I\u2019m prescribing a particular type of birth control pill, for example, because I have to wait and see what insurance will cover,\u201d she says.<\/span><\/p>\n

How much is birth control without insurance?<\/span><\/h2>\n

The <\/span>cost of birth control<\/span><\/a> without insurance varies considerably. Oral contraceptive pills tend to be the most affordable and cost about $35\u2013$270 for a one-month supply without insurance or discounts. Intrauterine devices (IUDs) are the most expensive prescriptions, ranging from around $1,150\u2013$1,600. The arm implant <\/span>Nexplanon<\/span><\/a> is also an expensive option, averaging over $1,500 per implant.<\/span><\/p>\n

When comparing birth control prices<\/a>, keep in mind the average lifespan of each option. For example, birth control patches and pills require a monthly refill (or every three months if your insurance pays for a three-month supply), but IUDs last three to 10 years, depending on the brand. Arm implants last for about three years, diaphragms expire after two years, and birth control shots are injected by a healthcare provider every three months.\u00a0<\/span><\/p>\n

If you don\u2019t have insurance or your insurance stopped covering birth control, consider whether it\u2019s worth paying a higher upfront cost to save money over time. Plus, IUDs and implants are the most effective birth control options, rated about as effective as sterilization by the <\/span>American College of Obstetricians and Gynecologists<\/span><\/a>.\u00a0<\/span><\/p>\n

What to do if your insurance won\u2019t cover birth control<\/span><\/h2>\n

If your insurance plan won\u2019t cover your birth control, don\u2019t wait to take action. You may be able to continue taking your birth control uninterrupted\u2014and for free\u2014 after a couple of phone calls.<\/span><\/p>\n

1. Contact your insurance company<\/span><\/h3>\n

When you lose birth control coverage, your first phone call should be to the insurance company. Find out exactly why the prescription is no longer covered. This information can help you and your healthcare provider decide how to proceed.<\/span><\/p>\n

2. Ask your healthcare provider to submit an exception request<\/span><\/h3>\n

As soon as possible, tell your healthcare provider that there\u2019s been a change in your prescription coverage. They can submit an exception request on your behalf.\u00a0<\/span><\/p>\n

An exception request asks the insurance company to cover a prescription that isn\u2019t normally covered. The request must include information about why the medication is medically necessary and why alternatives aren\u2019t appropriate.\u00a0<\/span><\/p>\n

Federal law <\/span>requires most insurance plans to cover at least one FDA-approved birth control method<\/span><\/a> in each category, as long as your healthcare provider considers it medically appropriate. If your preferred prescription is not covered, approval of the exception request will depend on your specific plan. If it\u2019s prescribed by an in-network provider, birth control has to be free\u2014no copay or coinsurance required. But because laws are complex, there may be exceptions.\u00a0\u00a0\u00a0<\/span><\/p>\n

3. Consider paying out-of-pocket temporarily<\/span><\/h3>\n

Consider temporarily paying out of pocket while you wait for a decision about your exception request. You may be able to get reimbursed by the insurance company if they grant the exception request, so save your receipts.\u00a0<\/span><\/p>\n

Paying out-of-pocket for your tried-and-true birth control may be more affordable than you think, and it may be feasible long-term. Ask your pharmacist how much it costs, and keep reading to find out how you can save even more.<\/span><\/p>\n

4. Use a backup method in the meantime\u00a0<\/span><\/h3>\n

In the best-case scenario, your exception request will be granted quickly. But there may be delays, and if your healthcare provider decides to start you on a new birth control method, you may have to wait for it to <\/span>reach full effect<\/span><\/a>. Use an effective backup method to prevent pregnancy in the meantime. You can talk to your healthcare provider about which backup method is best for you.<\/span><\/p>\n

Over-the-counter birth control options include:<\/span><\/p>\n